ABSTRACT
This study investigated the antibiotic susceptibility pattern of Pseudomonas aeruginosa isolated from clinical specimens, from in-patient, out-patient and intensive care unit of Abia State specialist hospital. Clinical specimens which include wound, urine, sputum, were analyzed for Pseudomonas aeruginosa. Forty eight isolates of Pseudomonas aeruginosa were isolated using standard bacteriological procedure. The isolated pathogen showed resistance to Ciprofloxacin (33.33%), Streptomycin (83.33%), and showed susceptibility to Levoflaxocin (87.50%), Ceftriaxone (81.25%) Gentamycin (79.16%). From the result obtained, Pseudomonas aeruginosa isolates from in-patient and out patient, intensive care unit of Abia state specialist hospital were highly susceptible to Levofloxacin (87.50%) and Gentamycin (79.16%) than other antibiotics. Hence, the use of antibiotics should be monitored among the group to avoid further drug resistance.
TABLE OF CONTENT
Title page i
Cover page ii
Certification iii
Dedication iv
Acknowledgement v
Abstract vi
Table of content vii
List of table viii
CHAPTER ONE
INTRODUCTION
1.0 Background of the Study 1
1.1 Statement of Problem 3
1.2 Significance of Study 4
1.3 Limitations of the Study 4
CHAPTER TWO
2.1 Literature Review 7
2.2 Clinical Manifestation 8
2.3 Antibiotic Resistance 11
2.4 Theoretical Framework 13
2.5 Current Therapeutic Options 14
CHAPTER THREE
METHODOLOGY
3.0 Materials and Method 20
3.1 Setting 20
3.2 Specimen Collection and Processing 20
3.3 Media Preparation 22
3.4 Biochemical Test 22
3.5 Susceptibility Test 24
CHAPTER FOUR
4.0 Result 25
4.1 Patients and Specimen Data 25
CHAPTER FIVE
5.1 Discussion 30
5.2 Conclusion and Recommendation 31
REFERENCES 32
LIST OF TABLE
Table 4.1: Age and Sex Distribution of Patients Infected with
Pseudomonas aeruginosa 26
Table 4.2: Distribution of Specimens from where Pseudomonas
aeruginosa was Isolated 27
Table 4.3: Bacterial isolated from patients in various wards 28
Table 4.4: Antibiotic Susceptibility Pattern of Pseudomonas
aeruginosa from Clinical Specimens. 29
CHAPTER ONE
INTRODUCTION
1.0 BACKGROUND OF THE STUDY
Pseudomonas aeruginosa is a gram negative, aerobic non spore forming, straight or slightly curved rod -shaped bacterium that occurs as single bacterium or in pairs and occasionally in short chains. Pseudomonas aeruginosa is an epitome of opportunistic nosocomial pathogen, which causes a wide spectrum of infection and leads to substantial morbidity in immuno- compromised patient .despite the therapy, the mortality due to nosocomial pseudomonal pneumonia is average. Unfortunately, pseudomonas aeruginosa demonstrate resistance to multiple antibiotics, thereby jeopardizing the selection of appropriate treatment. Therefore the present study was undertaken to find out the antibiotics susceptibility pattern of pseudomonas aeruginosa isolated from clinical specimens. It is widely distributed in nature including soil, water and various types of vegetation throughout the world. Besides that it has also revealed its presence in disinfectants, respiratory, equipment, sinks, taps and mops within the hospital as a bioflim. This organism found its entry into the hospital environment either through visitors and patients or goods that enter the hospital. Contact transmission is common mode of transmission in hospital (Arora and Romit et al., 2011).
Pseudomonas aeruginosa is an opportunistic nosocomial pathogen. It is a major threat to hospitalized and immuno-compromised patient. Particularly those who are deliberated or immuno comprised. Also those with diseases such as cancer, burns. The high mortality associated with these infections is due to the combination of weak host defense system bacteria resistance to antibiotics. Pseudmonas aeruginosa infection can develop in many anatomic sites including skin, bones ,ears , eyes , urinary tract ,. The site may vary with the portal of entry and the patient vulnerability. In hospitalized patients, the first sign may be overwhelming gram negative sepsis. (Doern, et al., 2005).
Today Pseudmonas aeruginosa is feared as dangerous opportunistic bacterium responsible for frequently lethal nosocomia infections , it is resistant to many disinfecting agents and highly resistant against most antibiotics (Aloush and Seigman-Igray et al., 2006).
Multiple antibiotic resistance in bacteria population is a pervasive and growing chemical problem , which is recognized as a threat to public health . The development of resistance to all available antibiotic in some organism may preclude the effectiveness of any antibiotic regimen (2.3). infections caused by Pseudmonas aeruginosa are frequently life threatening and difficult to treat as it exhibits intrinsically high resistance to many antimicrobials and the development of increased , particularly multi-drug resistance in heath care setting .Mechanism that cause antimicrobial drug resistance and multi drug resistance in Pseudmonas aeruginosa are due to acquisition of resistance genes (example those encoding beta- lactamase and amino-glycoside modifying enzymes via horizontal gene transfer and mutation of chromosomal genes (target ) site, efflux mutations ) are the target of the floroguinolones particular ciprofloxacin.
Biofilm formation in Pseudmonas aeruginosa, particularly in the cause of pulmonary infections in patient with cystic fibrosis , contribute to its resistance to antimicrobial agents hypermutable (or mutator) strains of Pseudmonas aeruginosa exhibiting increase mutation rates are common in chronic infections such as those that occur in the lungs of cystic fibrosis patient . Increase in the frequency of multi-drug resistance (MDR) stains of Pseudomonas aeruginosa has severally limited the availability of therapeutic options.
1.1 STATEMENT OF PROBLEM
It is a major threat to hospitalized and immune- compromised patients ,particularly those with disease such as cancer and burns . The high mortality associated with these infections is due to a combination of weak host defense system and bacteria resistance to antibiotics. Resistance of this notorious bacterium to commonly used antimicrobial agent is becoming an increasing clinical problem and a recognized public health threat because there are limited number of antimicrobial agents including the an un pseudomonas penicillin’s, cephalosporin’s , carabapenems ,aminoglycoside and fluoroguinoilones with reliable activity against it . It has intrinsic resistance to many antimicrobial agents and only a few antimicrobial agents have potent antibacterial activity against its bacterium. (Thornton et al., 2004).
The emergence of multidrug resistance (MDR) Pseudmonas aeruginosa has become a serious problem. There are several mechanisms which may contribute to the microbial resistance among pseudomonas aeruginosa including the production of chromosomally encoded B-Lactamases. (Liverrmore, 2000).
Aim: to determine the prevalence and antibiogram of pseudomonas aeruginosa from clinical samples
Objectives
a) To isolate and identify Pseudomonas aeruginosa from clinical specimens..
b) To determine the pattern of antibiotic sensitivity of pseudomonas aeruginosa from such clinical specimens.
1.2 SIGNIFICANCE OF STUDY
Majority of isolates were recovered from patient on admission, this observation affirmed the significant role of this organism in nosocomical infection, similarly was the pattern in wound specimens. The unique feature of pseudomonas aeruginosa, isolates is the resistance of Varity of antibiotics, primarily attributed to low permeability of the cell wall, production of inducible cephaloporinase, active efflux and poor affinity for target (DNA gyrase). Aminoglycosides, especially gentamicin and streptomycin knowing frontline antibiotic in the treatment of bacteria. However, emerging reports showed increased prevalence of resistance to these drugs. Pseudomonas aeruginos has received the most attention. it is ubiquitous free living bacterium and is found in most moist environment..Although it seldom causes disease in healthy individuals, it is a major treat to hospitalized and immuno-compromised patients, particularly those with serious under laying disease such cancer and burns. It also help in the investigating the pattern of antibiotic resistance to test antibiotics and help us in determining the role of combination therapy in its management. This study suggests the use of triple antimicrobial therapy( meropenam, sulzone and amikacin) can be a useful alternative treatment for multidrug resistant (MDR).
1.3 LIMITATIONS OF THE STUDY
Comparison of epidemiological data of bacterial pathogens as in this study might be difficult as there are other variables that influences the outcome of results such as clinical specimens received for examination , studied population , types of hospitals and geographical locations . However, the possibility of Pseudomonas aeruginosa contamination of wounds cannot be ruled out , this is possible environment whose strict hand washing procedures is not strictly adhered to and unhygienic procedure especially in wound dressing may be a contributor factors. ( Iregu et al., 2002).
Difference in the resistance pattern may be attributed to factors like exposure to antibiotics studied population, type of clinical specimen examined. the clinical implication is that there is need for evaluation of the efficacy of cephalosporin in the treatment of pseudomonal infection in order to prevent treatment failure a scenario that often common in management of Pseudomonas infections .Most disturbing pattern observed in this study was the multidrug resistance exhibited by most of the isolates.
The multidrug resistance by Pseudomonas aeruginosa isolated in this management and infection control approach in hospital environments also the high mortality associated with these infections is also due to a combination of weakened host defenses and production of extracellular bacteria enzymes and toxins.
Treatment of Pseudomonas aeruginosa is a challenge because resistance limits dramatically therapeutic options. antibiotics resistant organisms appear to be biological fit and are capable of causing serious life threatening infection that are difficult to management because treatment options are limited , this increases in the prevalence of drug resistant pathogenesis occurring at a time when the discovery and development of new anti infection agents is showing down dramatically . In fact the irrational and inappropriate use of antibiotics is responsible for the development of resistance of Pseudomonas species to antibiotics immunotherapy . hence there is need to emphasize the rational use of antimicrobials and strictly adhere to the concept of reverse drugs to minimize the use of available antimicrobials . In addition regular antimicrobial surveillance is essential for the area wise (Humasuna, et al., 2004) monitoring of the resistance patterns. An effective national and state level antibiotics policy and draft guidelines should be introduced to preserve the effectiveness.
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